Diabetologia ( IF 8.4 ) Pub Date : 2021-08-16 , DOI: 10.1007/s00125-021-05541-0 Samantha B J Schipper 1, 2 , Maaike M Van Veen 3, 3 , Petra J M Elders 2, 4 , Annemieke van Straten 2, 5 , Ysbrand D Van Der Werf 6, 7 , Kristen L Knutson 8 , Femke Rutters 1
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Sleep disorders are linked to development of type 2 diabetes and increase the risk of developing diabetes complications. Treating sleep disorders might therefore play an important role in the prevention of diabetes progression. However, the detection and treatment of sleep disorders are not part of standardised care for people with type 2 diabetes. To highlight the importance of sleep disorders in people with type 2 diabetes, we provide a review of the literature on the prevalence of sleep disorders in type 2 diabetes and the association between sleep disorders and health outcomes, such as glycaemic control, microvascular and macrovascular complications, depression, mortality and quality of life. Additionally, we examine the extent to which treating sleep disorders in people with type 2 diabetes improves these health outcomes. We performed a literature search in PubMed from inception until January 2021, using search terms for sleep disorders, type 2 diabetes, prevalence, treatment and health outcomes. Both observational and experimental studies were included in the review. We found that insomnia (39% [95% CI 34, 44]), obstructive sleep apnoea (55–86%) and restless legs syndrome (8–45%) were more prevalent in people with type 2 diabetes, compared with the general population. No studies reported prevalence rates for circadian rhythm sleep–wake disorders, central disorders of hypersomnolence or parasomnias. Additionally, several cross-sectional and prospective studies showed that sleep disorders negatively affect health outcomes in at least one diabetes domain, especially glycaemic control. For example, insomnia is associated with increased HbA1c levels (2.51 mmol/mol [95% CI 1.1, 4.4]; 0.23% [95% CI 0.1, 0.4]). Finally, randomised controlled trials that investigate the effect of treating sleep disorders in people with type 2 diabetes are scarce, based on a small number of participants and sometimes inconclusive. Conventional therapies such as weight loss, sleep education and cognitive behavioural therapy seem to be effective in improving sleep and health outcomes in people with type 2 diabetes. We conclude that sleep disorders are highly prevalent in people with type 2 diabetes, negatively affecting health outcomes. Since treatment of the sleep disorder could prevent diabetes progression, efforts should be made to diagnose and treat sleep disorders in type 2 diabetes in order to ultimately improve health and therefore quality of life.
Graphical abstract
中文翻译：
2 型糖尿病患者的睡眠障碍及相关健康结果：文献综述
睡眠障碍与 2 型糖尿病的发生有关，并会增加发生糖尿病并发症的风险。因此，治疗睡眠障碍可能在预防糖尿病进展方面发挥重要作用。然而，睡眠障碍的检测和治疗并不属于 2 型糖尿病患者标准化护理的一部分。为了强调睡眠障碍对 2 型糖尿病患者的重要性，我们回顾了有关 2 型糖尿病患者睡眠障碍患病率以及睡眠障碍与健康结果（如血糖控制、微血管和大血管并发症）之间关系的文献、抑郁、死亡率和生活质量。此外，我们还研究了治疗 2 型糖尿病患者的睡眠障碍在多大程度上改善了这些健康结果。我们在 PubMed 上进行了从成立到 2021 年 1 月的文献检索，使用的搜索词包括睡眠障碍、2 型糖尿病、患病率、治疗和健康结果。观察性研究和实验性研究均包含在该综述中。我们发现，与一般人群相比，2 型糖尿病患者中失眠 (39% [95% CI 34, 44])、阻塞性睡眠呼吸暂停 (55–86%) 和不宁腿综合征 (8–45%) 更为普遍人口。没有研究报告昼夜节律睡眠-觉醒障碍、中枢性嗜睡症或异态睡眠障碍的患病率。此外，几项横断面和前瞻性研究表明，睡眠障碍对至少一种糖尿病领域的健康结果产生负面影响，尤其是血糖控制。例如，失眠与 HbA 1c水平升高相关（2.51 mmol/mol [95% CI 1.1, 4.4]；0.23% [95% CI 0.1, 0.4]）。 最后，研究治疗 2 型糖尿病患者睡眠障碍效果的随机对照试验很少，且参与者人数较少，有时还没有结论。减肥、睡眠教育和认知行为疗法等传统疗法似乎可以有效改善 2 型糖尿病患者的睡眠和健康状况。我们的结论是，睡眠障碍在 2 型糖尿病患者中非常普遍，对健康结果产生负面影响。由于治疗睡眠障碍可以预防糖尿病进展，因此应努力诊断和治疗 2 型糖尿病患者的睡眠障碍，以最终改善健康状况，从而提高生活质量。
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